Darzi review must present a ‘clear vision’ of reform
pharmafile | June 27, 2008 | News story | |Â Â hcÂ
Ministers must clearly explain what NHS reforms are meant to achieve if they want them to succeed, according to an independent expert working group.
Chaired by King's Fund chief executive Niall Dickson, the group also advises that clearer rules are needed for dealing with failing trusts and that PCTs should appoint independent clinical panels to advise on commissioning.
The group was commissioned by The King's Fund and charged with producing recommendations to inform Lord Darzi's Next Stage Review, which is due to be published next week.
The main points are:
* First, and most importantly, ministers need a 'unifying narrative' to "re-state clearly the future direction of travel for the reformed system". In other words they need to be explicit about the fact that the Department of Health will be responsible for setting NHS standards, goals and priorities, but that operations will be a matter for the NHS itself – which will in turn increasingly become a commissioning organisation, leaving care provision in the hands of regulated but freestanding organisations.
* The Department of Health should draw up clearer rules for dealing with providers which fail and which may even need to be removed from the NHS system.
* Strategic health authorities must develop a set of positive incentives for the performance of PCTs as commissioners, trying different approaches in different areas but sharing best practice.
* The Department of Health should develop detailed quality indicators for PCTs to routinely use in contracts alongside patient-reported outcome measures.
* Public consultation should be based on commissioners' service strategies and specifications – not on providers' plans for meeting those requirements.
* PCTs should be helped to focus on their new commissioning role, by giving them a clear timetable for the divestment of their functions as providers.
* PCTs should appoint independent clinical panels to advise on commissioning.
* GPs who want to provide a wider range of services should be commissioned as principal contractors.
* In primary and community care the market should be opened up so that these services are eventually commissioned on the same basis as other services.
* The Department of Health should continue to encourage choice through the publication of detailed quality metrics, including patient-reported outcome measures.
Underpinning the group's work is the assumption that NHS reforms are designed to create a decentralised, self-improving, responsive system "where day-to-day ministerial involvement becomes redundant and the need for centralised performance management is much reduced".
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